NAC (N-acetyl-cysteine)


Why NAC?

NAC is a powerful antioxidant

As an antioxidant, NAC provides multiple benefits to a body under severe oxidative stress from SARS-Cov-2:

NAC suppresses cytokine storm-inciting molecules and cells

NAC improves oxygenation without ROS generation

May work synergystically with antivirals

NAC is an Anti-inflammatory/immunomodulatory agent

Severe respiratory disease progressing to ARDS from COVID-19 illness appears to be from cytokine storm syndrome (Mehta et al)

NAC has potential for attenuating/mitigating/preventing cytokine storm and ensuing ARDS. NAC has already been shown to inhibit pro-inflammatory molecules by suppressing TNF and IL-6 (molecules that regulate inflammatory complications leading to ARDS).

NAC rescued cell swelling, downregulated the inflammatory response, and prevented pyroptotic death in hypoxia-cultured myoblasts (Yu et al)

NAC has antiviral activity 

NAC may have antiviral properties (Fraternale et al, Ciriolo et al) and has been tried to treat other viral pneumonias: influenza A (Casanova et al, Geiler et al), H1N1 (De Flora et al). 

NAC has been investigated for use vs HIV and was found to suppress replication in 1991 - pre-antiretroviral cocktail therapy (Kalebic et al including Fauci AS).


NAC has anticoagulant/antithrombotic activity 

With concerns that SARS-COV-2 produces a hypercoagulable state (Bikdeli et al), NAC anticoagulant/thrombotic properties may also be beneficial

(Jang et al, Martinez de Lizarrondo et al, Niemi et al, Wang et al)

NAC has already been shown to work favorably in other pulmonary disease processes

Minimal/negligible side effects of NAC 

NAC has a longstanding track record of having an excellent safety profile

In general, it has a very low side-effect profile, especially in oral administration

IV dosing: rare anaphylactoid (not anaphylactic) response (hypersensitivity rash, flushing; CV mild hypotension; Resp: rare bronchospasm) addressed with administration of diphenhydramine and restart of medication at lower rate.